An anal fissure which does not heal with conservative measures as sits baths and laxatives is a chronic anal fissure. Physiologically, it is the high resting tone of the internal anal sphincter that chiefly interferes with the healing process of these fissures. Until now, the gold standard treatment modality is surgery, either digital anal dilatation or lateral sphincterotomy. However, concerns have been raised about the incidence of faecal incontinence after surgery. Therefore, pharmacological means to treat chronic anal fissures have been explored.A Medline and pub med database search from 1986-2012 was conducted to perform a literature search for articles relating to the non-surgical treatment of chronic anal fissure.Pharmacological sphincterotomy using Glyceryl trinitrate , Isosorbide dinitrate or calcium channel blockers are exciting alternative treatment , that relaxes the anal sphincter and, therefore, promote healing, the drawback of such medications are headache and poor compliance. With the introduction of Botulinum toxin as mean of chemical sphincterotom, topical injection of Botulinum toxin reduces the anal hypertonia which lasts for few months, allows the fissure to heal, thus eliminating the need for surgery without incidence of incontinence. Cure rates are over 60%, and the procedure can be repeated safely. Therefore, Botulinum toxin is a reasonable first-line management of chronic anal fissure and the relapses can be managed by surgeryKeywords: Non-surgical treatment of anal fissure, fissure in ano, sphicterotomy,botulinum toxin in anal fissures, glyceryl trinitrate. Chemical sphincteratomy, pharmacological sphincteratomy.
Abstract
In this paper, fatigue damage accumulation were studied using many methods i.e.Corton-Dalon (CD),Corton-Dalon-Marsh(CDM), new non-linear model and experimental method. The prediction of fatigue lifetimes based on the two classical methods, Corton-Dalon (CD)andCorton-Dalon-Marsh (CDM), are uneconomic and non-conservative respectively. However satisfactory predictions were obtained by applying the proposed non-linear model (present model) for medium carbon steel compared with experimental work. Many shortcomings of the two classical methods are related to their inability to take into account the surface treatment effect as shot peening. It is clear that the new model shows that a much better and cons
... Show MoreIn "historical" fiction, characters that never really existed, give expression to the impact of historical events on the people who really did live through them. The result is not history, as an accurate record of actual events, but fiction in which an earlier age is rendered through the personal joys and sufferings of characters. This paper
aims at investigating the historical realities presented in Dickens’s A Tale of Two Cities.
This research aimed at recognizing the properties of curricula that fitted to preeminent and talent students. Many types of these curricula were exposed, enrichment curriculum was explained as one of alternatives of available curricula.
The research used the analytical methodology for local and international literature in the field of preeminent and talent education to meet the properties of curricula that fitted to this special group of students. Many results was obtained as:
• This type of school enrichment curriculum consists of three levels( general discovery activities, individual and groups training activities, and individual or groups real problems).
• Investigation the effectively both sides of brain: right and left,
The efficient removal of dissolved organic compounds (DOC) from wastewater has become a major environmental concern because of its high toxicity even at low concentrations. Therefore, a technique was needed to reduce these pollutants. Ion exchange technology (IE) was used with AmberliteTM IR120 Na, AmberliteTM IR96RF, and AmberliteTM IR402, firstly by using anion and mixed bed system, where the following variables are investigated for the process of adsorption: The height of the bed in column (8,10 and 14 cm), different concentrations of (DOC) content at constant flow rate. The use of an ion exchanger unit (continuous system) with three columns (cation, anion, and mixed bed) was studied.
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This study aimed to identify the employment of the social networking platform «Twitter» in the 2016 presidential campaign led by the Republican candidate, Donald Trump; and analyse his tweets through his personal account on «Twitter» for the period from: 10/ 8/2016 to: 11/ 8/2016 which represents the last month of the election campaign.
The study belongs to the type of descriptive studies using the analytical method through an analysis index that includes sub-categories and other secondary categories. The research has adopted the ordinary unit of information material (tweet) as an analysis unit for this purpose.
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The research problem lies in the ambiguity of the usage of propaganda contents by two main media outlets (the Russian RT and American Alhurra) in their news coverage of the Syrian crisis through their websites and the methods used by them to convince users taking into account the mutual propaganda conflict between the United States and Russia in the war against Syria. The objectives of the research can be represented by the following: investigating the contents of American and Russian electronic propaganda towards Syrian crisis.
• Identifying the contents that received most of the coverage in the Syrian crisis by the two news outlets.
• Identifying the terms and phrases that have been most used by the websites of RT and Alhurr
Introduction: Diabetic foot infections are one of the most severe complications of diabetes. This study was aimed to determine the common bacterial isolates of diabetic foot infections and the in vitro antibiotic susceptibility then treatment.
Methods: A swab was taken from the foot ulcer, and the aerobic bacteria were isolated and identified by cultural, microscopic and biochemical test, then by api-20E system. After that their antibiotic susceptibility pattern was determined. Then local and systemic treatment was used to treat the diabetic foot patients.
Results: Bacterial isolates belonging to twelve species were obtained from diabetic foot patients. Gram (-) bacteria were the predominant pathogens in the diabetic foot infection
Abstract
This research aims to design a multi-objective mathematical model to assess the project quality based on three criteria: time, cost and performance. This model has been applied in one of the major projects formations of the Saad Public Company which enables to completion the project on time at an additional cost that would be within the estimated budget with a satisfactory level of the performance which match with consumer requirements. The problem of research is to ensure that the project is completed with the required quality Is subject to constraints, such as time, cost and performance, so this requires prioritizing multiple goals. The project
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In this work, a single pile is physically modeled and embedded in an upper liquefiable loose sand layer overlying a non-liquefiable dense layer. A laminar soil container is adopted to simulate the coupled static-dynamic loading pile response during earthquake motions: Ali Algharbi, Halabjah, El-Centro, and Kobe earthquakes. During seismic events with combined loading, the rotation along the pile, the lateral and vertical displacements at the pile head as well as the pore pressure ratio in loose sandy soil were assessed. According to the experimental findings, combined loading that ranged from 50 to 100% of axial load would alter the pile reaction by reducing the pile head peak ground acceleration, rotation of the pile, and lateral displacem
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Abstract: The researcher aims to highlight the historical frames of political development in royal regime era (1921-1949) and study its transitions on social-political aspect for the various periods during this consistent era of Iraq history. As some elements played an important role in shaping this era’s features ,as well as 2hat succeed it, which mainly affected the political progression’s configuration, such as : political culture role, social and cultural foundation, state policy essence and the unofficial institutions remarkable role in influencing public awareness and concerning it's relation to the state ,the clan and religious institutions. The researcher employed Alexis de Tocqueville’s evaluation criteria and indi
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